İntertrokanterik Femur Kırığı Tedavisinde Proksimal Femoral Çivileme ve Bipolar Hemiartroplasti Tekniklerinin İntraoperatif ve Postoperatif Sonuçlarının Karşılaştırılması

Amaç: Bu çalışma, benzer özelliklere sahip hasta grubunda bipolar hemiartroplasti ile proksimal femoral çivileme arasında kısa ve uzun dönem cerrahi, klinik ve fonksiyonel sonuçları karşılaştırmak amacıyla yapılmıştır. Gereç ve Yöntemler: Proksimal femur çivileme ve bipolar hemiartroplasti uygulanan kalça kırığı olan hastalar için, üçüncü basamak bir hastanenin iki yıllık verilerinin geriye dönük taraması yapıldı. 67 proksimal femoral çivileme uygulanan hasta ve 74 bipolar hemiartroplasti uygulanan hasta çalışmaya dahil edildi. Her bir hastanın kısa ve uzun vadeli sonuçları ile ameliyat öncesi, ameliyat sırasındaki ve ameliyat sonrası özellikleri kayda alındı. Bulgular: Her iki grubun demografik özelliklerinde istatistiksel olarak anlamlı bir farklılık yoktu. Bipolar hemiartroplasti uygulanan grupta ameliyat sırasındaki ortanca kan kayıp miktarı proksimal femoral çivileme uygulanan gruba göre anlamlı derecede daha yüksekti (sırasıyla 450 cc’ye karşı 350 cc; p<0,001). Bipolar hemiartroplasti prosedürünün, proksimal femoral çivileme prosedüründen daha fazla ameliyat sırasında transfüzyon ihtiyacı ile ilişkili olduğu saptandı (p=0,007). Sadece bipolar hemiartroplasti yapılan hastalarda ameliyat sırasında komplikasyon varlığı rapor edilmiştir. Yoğun bakım ihtiyacı bipolar hemiartroplasti grubunda, proksimal femoral çivileme grubuna göre, sırasıyla %86,5 (n=64) ve %68,7 (n=46) oranları ile anlamlı derecede daha yüksekti (p=0,011). Sonuç: Bu çalışmanın sonuçlarına göre, kalça kırığı olan hastalarda proksimal femoral çivileme prosedürü hem ameliyat sırasındaki komplikasyonlar ve hem de ameliyat sonrası yoğun bakım ihtiyacı açısından daha güvenilir bir cerrahi teknik olarak görünmektedir.

Anahtar Kelimeler:

yaşlılar, hemiartroplasti, intertrokanterik kırık, proksimal femur çivileme, cerrahi sonuçlar

Comparison of Intraoperative and Postoperative Outcomes of Proximal Femoral Nailing and Bipolar Hemiarthroplasty Techniques in Intertrochanteric Femur Fracture Treatment

Aim: This study was undertaken with the purpose of comparing the short and long term surgical, clinical, and functional results between bipolar hemiarthroplasty and proximal femoral nailing in the same cohort of patients. Material and Methods: The retrospective scanning of two-year data of a tertiary care hospital has been carried out for patients with hip fractures undergoing proximal femoral nailing and bipolar hemiarthroplasty. 67 patients underwent proximal femoral nailing and 74 patients underwent bipolar hemiarthroplasty were included in the study. Each patient's short and long term outcomes were documented as well as their preoperative, intraoperative, and postoperative features. Results: There were no significant differences in the demographic features of both groups. The median intraoperative blood loss was significantly higher in the group who underwent bipolar hemiarthroplasty compared to the group who underwent proximal femoral nailing (450 cc vs 300 cc, respectively, p<0.001). It was found that the bipolar hemiarthroplasty procedure was associated with a greater need for intraoperative transfusion than the proximal femoral nailing procedure (p=0.007). Intraoperative complications were reported only in patients who underwent bipolar hemiarthroplasty. The need for intensive care unit was significantly higher in the bipolar hemiarthroplasty group than in the proximal femoral nailing group, with the rate of 86.5% (n=64) and 68.7% (n=46), respectively (p=0.011). Conclusion: According to the results of this study, the proximal femoral nailing procedure appears to be a more reliable surgical technique in patients with hip fractures in terms of both intraoperative complications and the postoperative need for an intensive care unit.

Keywords:

elderly, hemiarthroplasty, intertrochanteric fracture, proximal femur nail, surgery outcome,

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Gashi YN, Elhadi AS, Elbushra IM. The outcome of primary cemented bipolar hemiarthroplasty compared with dynamic hip screw in elderly patients with unstable intertrochanteric fracture. Malays Orthop J. 2018;12(1):36-41.
Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18(1 Suppl):57s-63s.
Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. J Clin Orthop Trauma. 2019;10(2):296-301.
Tay E. Hip fractures in the elderly: operative versus nonoperative management. Singapore Med J. 2016;57(4):178-81.
Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377(21):2053-62.
Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ. 2006;332(7547):947-51.
Lieten S, Herrtwich A, Bravenboer B, Scheerlinck T, Van Laere S, Vanlauwe J. Analysis of the effects of a delay of surgery in patients with hip fractures: outcome and causes. Osteoporos Int. 2021;32(11):2235-45.
Vidán MT, Sánchez E, Gracia Y, Marañón E, Vaquero J, Serra JA. Causes and effects of surgical delay in patients with hip fracture: a cohort study. Ann Intern Med. 2011;155(4):226-33.
Orosz GM, Magaziner J, Hannan EL, Morrison RS, Koval K, Gilbert M, et al. Association of timing of surgery for hip fracture and patient outcomes. JAMA. 2004;291(14):1738-43.
Ekinci Y, Gürbüz K, Batın S, Kahraman M, Doğar F, Kaya Erten Z. A multicenter intertrochanteric fracture study in the elderly: Hemiarthroplasty versus proximal femoral nailing. Jt Dis Relat Surg. 2020;31(2):209-17.
Özkayın N, Okçu G, Aktuğlu K. Intertrochanteric femur fractures in the elderly treated with either proximal femur nailing or hemiarthroplasty: a prospective randomised clinical study. Injury. 2015;46(Suppl 2):S3-8.
Zhou S, Liu J, Zhen P, Shen W, Chang Y, Zhang H, et al. Proximal femoral nail anti-rotation versus cementless bipolar hemiarthroplasty for unstable femoral intertrochanteric fracture in the elderly: a retrospective study. BMC Musculoskelet Disord. 2019;20(1):500.
Tan WL, Shi YX, Zhang JY, Tang CR, Guan QB, Tan JJ. Bipolar hemiarthroplasty should not be selected as the primary option for intertrochanteric fractures in elderly patients aged 85 years or more. Medicine (Baltimore). 2020;99(37):e21862.
Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop. 2020;44(4):623-33.
Yong EL, Ganesan G, Kramer MS, Howe TS, Koh JSB, Thu WP, et al. Risk factors and trends associated with mortality among adults with hip fracture in Singapore. JAMA Netw Open. 2020;3(2):e1919706.
Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV. Risk factors for in-hospital post-hip fracture mortality. Bone. 2011;49(3):553-8.
LeBlanc ES, Hillier TA, Pedula KL, Rizzo JH, Cawthon PM, Fink HA, et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med. 2011;171(20):1831-7.